Nonsurgical Treatment for Adhesive Capsulitis

Nonoperative treatment commonly begins with measures to reduce shoulder pain and inflammation including topical treatments of heat, ice, transcutaneous electric stimulation, transcutaneous salves and balms, acupuncture, massage and systemic medications [nonsteriodal anti-inflammatory drug (NSAID) class medicines and oral corticosteroids]. The relative contribution to recovery that any of these treatment measures provide remains unclear and their use at this time is best individualized based upon the response each individual patient manifests during their use. Many other treatment regimens including trigger point injections, suprascapular nerve block, ultrasound, and the injection of hyaluronic acid have been studied and found to have no demonstrable long term benefit. Intra-articular injections of corticosteroid medications are often used to relieve the symptoms of painful inflammation and some believe they may alter the inflammatory process within the glenohumeral capsule. We have observed that the use of intra-articular steroids coupled with range of motion therapy can result in a “rapid and striking improvement” if administered early in Stage 1 adhesive capsulitis and can even provide “significant improvement” during Stage 2 disease. Other investigators have found no long term improvement in outcome when these injections are used. The mainstay of nonoperative treatment for adhesive capsulitis is the administration of range of motion stretching therapy. This may be accomplished by the patient on their own at home; it can be administered by a physical therapist, or most commonly as a combination of both. Review of numerous articles in the orthopaedic and physical therapy literature reveal the reported success rate for formal physical therapy to average between 50% to 70% of patients. Miller have reported their results with a patient administered home therapy program directly supervised by the treating orthopaedist, which they call “Orthotherapy.” At an average of 14 months treatment, they observed that 100% of patients were improved, having painless range of motion within 20% of normal or having no restriction during activities of daily living. Other researchers, however, have had less success with nonoperative treatment regimens. Griggs reported that with an average 22 months of follow-up, 50% of their patients had abnormal function, 37% continued to have pain, and 10% were not satisfied. Shaffer reported results after an average follow-up of 7 years and found 60% of patients had a persisting deficit in range of motion measuring between 10% to 30% of normal, 50% of their patients had continuing pain or a sense of stiffness and 11% felt they experienced continuing restriction in function.